2011 Trip with Bob Flaws and Honora Wolfe
Last week 4 volunteers, Bob Flaws, Honora Wolfe, and I all landed here in Nepal safely and happily ready to volunteer at the Sechen Clinic. Bob and Honora had been in Nepal for a week already, setting things up at the clinic, and getting used to the run of the place again, after a year absence since their last trip here. Amy Chavez, Jackie Koekkoek, Amanda Kreiss, and Ferran Blasco, all licensed acupuncturists hailing from both the US and Spain, joined in the second week to observe Bob and Honora in clinic as well as lend a hand treating patients and organizing the clinic. We arrived with 4 large suitcases of supplies, thanks to our primary sponsors, Blue Poppy, Legendary, Asiamed, and KPC. The girls made light work of the inventory process and we are so grateful for their help. Sonam, our translator and Chinese Medicine trainee, was given a laptop computer this trip so that she can keep track of inventory in the clinic, as well as keep in touch with our Curriculum Advisor, Richard Blitstein, LAc. Rich has been administering exams to Sonam via volunteers, but now can do so himself via Skype.
It is wonderful to be back again in this place that feels so much like home. We hit the ground running with a trip to the White Gompa where Chokyi Nyima Rinpoche is holding his annual seminar. The seminar lasts 8 days, with teachings from Rinpoche from 9-12. The first part of each day consists of instruction and meditation practice, the second half is dedicated to a text. Somehow CNR always makes these teachings so accessible to all people who want to work on becoming good people, peaceful and kind people. I took the volunteers to meet Rinpoche at the break, and to offer kata and a small donation. Amy asked me how you know when you meet your teacher, and as I was explaining the feeling of a connection to a teacher, her eyes welled up with tears as she looked at Chokyi Nyima for the first time. “I would say that’s a connection right there,” I told her.
The next day was our first day in clinic and the morning was a busy one, treating 25 patients. Bob taught and treated in one room with Amanda and Ferran, Honora in the next room with Amy and Jackie. Everyone was happy to see Bob and Honora back again and I am sure word will be spreading fast of their presence here.
Mindfulness, Desire, and Sharon Salzberg
Sharon’s relaxed, non-sectarian, and totally uncomplicated approach to meditation practice welcomes anyone who would like to develop ways to alter their relationship to events in their lives. One of the ideas she discussed was that Happiness doesn’t come from the ups (or downs) in life. Whenever we look to experiences or material objects to happiness, we will always end up disappointed. How many times have you really craved and desired something only to find that when the object of your desire is there, you have already moved on to the next desire. I saw this phenomenon in my own consciousness while on retreat in Thailand years ago. I ended up at a forest monastery outside Chiang Mai. It wasn’t the forest monastery I was headed to, the one I knew where my respected teacher was, but due to a nap on the way and a confused Songteaw driver, I ended up here. Ok, no problem, the abbot kindly let me come and do my practice for 10 days in silence. I was working on observing and noting absolutely everything that happened to me in a day. While sometimes tedious, this practice revealed so much about my mind.
I developed a routine which, as I often do, I clung to for stability and security. It was sitting from 4am-9pm with some intermittent breaks for walking meditation, breakfast, and my favorite break- the soymilk break. This was my evening meal, a “juicebox” of soymilk. I looked forward to it pretty much from the end of lunch at noon, until I got to drink it at about 7pm. One day I remember sitting in the caves and the knowledge that I would be drinking that sweet delicious drink soon starting coming to me. I should say here that soymilk juiceboxes in Thailand are much tastier than they may sound to an American. I think the sugar:soybean ratio is close to 50:1. Or something like that. Kids enjoy this drink on a daily basis, so you know it has to be sweet and non soy tasting. Anyway, when I thought of the soymilk and that i would get to stop meditating, walk to the kitchen, sit down and then drink this tasty treat, I felt a thrill inside me! As the hours got closer to the break, I could feel the anticipation rising. Each look at my watch I was that much closer to pure delight! Finally the time came to leave the cave and start my walk towards my evening nectar. I walked slowly and deliberately to the kitchen. I sat down at my favorite stone stool. I opened the juicebox straw and inserted the plastic tool into the receptacle. I lifted the pale blue box to my lips and just before I tasted it, just before the milk started to flow into my mouth, a feeling came over me. A very strong, clear, obvious feeling. I didn’t want the soymilk anymore. That craving stopped. What did this mean that before I even get what I want, I don’t want it anymore? We’re not talking about being tired of something, getting bored with it because you had it too much, no that I can understand. But this? What I realized was something I see in my life all the time now. Just before I get something I supposedly want and think will make me happy, I stop wanting it. In the words of one of my teachers, it’s not the object that we crave, but craving itself. It’s true! And how silly is this mind that craves just to crave? If I don’t even want that object I longed for so much just before I get it, then obviously I can be happy without it. It’s the relationship to the longing that needs to change.
With this revelation I have been able to, or at least try to, see desire in my life as something to be observed and studied, but not always acted on, and not always “reality”. Whether that is material things, like a new Prius, or experiences like my boyfriend joining me on a meditation retreat (which he did since he knows what’s good for him!) it’s always the same. Desire is in part, a trick of the mind. When we can see it this way, everything changes. Now, this doesn’t mean that we don’t work for things. No no. I had to present many reasonable arguments for why he should accompany me on this retreat, but I still held on to the knowledge that this is a desire. There will be more and the moment just before I get it, I will even stop wanting it so much. It’s the wanting that I want. The act of craving itself that I am so used to and that i crave. So I see it, watch it, try not to put too much meaning into it, and see what happens.
Namobuddha Clinic, November 2010
Thrangu Rinpoche built this monastery in 1976, and later added a one room clinic to serve the residents of the area. Last year a new clinic was completed- 3 floors, over 20 rooms, including residents quarters for visiting doctors who volunteer here. The third floor has a large balcony overlooking the hills and beautiful green rice fields as well as the impressive buildings of the monastery itself which contains a main hall, 3 year retreat center, Thangka painting school, Shedra for advanced Buddhist studies, and primary and secondary school, also for the monks.
Our day yesterday consisted of treating about 25 patients in the acupuncture clinic, a slow day here and for most clinics I find myself in. But it was a nice way to ease into this place and gave me a chance to see how the newly trained monks are fairing with their patients. Dorje and Puchung took a 200 hour barefoot acupuncture training course last April and have been training in the clinic as their practum ever since. Ten monks were actually trained, but the others have spread to various monasteries in India, Nepal, and overseas. It was wonderful to work with Dorje and Puchung who know most of the important points and all the acupuncture channels. I wanted to give them a bit more theory so that they could take what they know and apply it more broadly. For example, they are often stuck in protocols for knee pain, asthma, and headache which they see so often. But when a patient comes in with menstrual pain, they wouldn’t be sure at all what to do. So we talked about the uses of all 12 primary channels and also reviewed what Bob Flaws and Honora Wolfe had taught in their class the weekend before.
I must go back down to the city today to meet with the local acupuncture school, visit the vajra varhi clinic manager, Dolpo Tulku, be a visiting instructor at at Shedra class on Buddhism and Humanitarian work, as well as see some visiting doctors who might want to join together in our work. There is much to be done in Boudha, which is why I am soaking up the last few hours of quiet monastic life up here. I woke up to clear blue skies and was able to practice yoga on the rooftop, which I shared with the solar panels used to heat the monastery’s water supply. There is a practice room right in the clinic for sitting meditation, which I am free to make use of whenever I want. I will join the monks for dahl bhat and vegetables for lunch before heading back to the hustle and bustle of life in the valley.
Namobuddha Clinic, October 2010
The 2 hour ride up the rocky mountain went quickly as we discussed how the clinic had been going for them the last 10 days. The clinic was closed for the Nepali holiday of Dasai, so we were taking the opportunity to visit the site of the new MMW acupuncture clinic inside the NamoBuddha grounds. The monastery created the brand new building for the clinic a few years ago and now treats patients 3 days a week. The other 2 days are focused on training the monks in Western medicine and now we will be training them in Acupuncture.The hills around this area are green and lush, and the first thing I notice is that I can breathe deeply and completely when I get to the top. Our knowledgeable guide, Gompo, take us around to the various halls, the school for monks, the 3 year retreat center, the tangka painting school, and finally to the site where, legend has it, the Buddha, in a previous incarnation, gave his life to feed a hungry lioness and her cubs. We offered katas and prayers for Mindful Medicine Worldwide and the patients we would be treating here.Pictures to come when my connection is better and uploading is slightly faster than snails pace. We being a one day workshop tomorrow for the trainees in all 3 clinics along with some Tibetan nuns who have been learning acupuncture for a few months now.
Thailand Revisited, May 2010
I arrived late at Ajarn Apinya’s house in a small newish subdivision of houses in Chiang Mai. It was late already and we had to be up at 5am the next morning to go to the temple to meet Pra Ajarn and then up to the Thai-Burmese border where we would search out a new clinic site for MMW. So, after I presented Apinya with a purple pasmina and many thanks for helping with this project, we went to sleep.
The next morning at 5am promptly we were on the way to MaeWang, about 45 minutes outside of Chiang Mai and the area where my first meditation teacher, Pra Ajarn Neewin, is the abbot of the forest monastery called Wat Tum Doi Tone, which means the temple in the caves. There is a huge cave where most meditation takes place. At least it did until Pra Ajarn took on the large task of making the monastery into an almost full-time retreat center. He has already finished the 2 year long construction of a new meditation hall, a community eating area, men’s dorm, and now the beginning of the women’s dormitory that will house 65 female retreatants. Everything he does is with astounding beauty and the new buildings are no exception. All the buildings face the center of the monastery, which is a green field surrounded by healthy flowers, trees, and plants. Of course sitting in the caves is till an option, but the new hall is more convenient and less batty!
We arrived and had a quick breakfast, but when Pra Ajarn came out to meet us he informed us that he was sick and had been for almost a week and so he wouldn’t be able to join us to the border. Instead he was sending his trusty second in command, the smiling Pra Suriporn. So we set off in the temple car for the 4-hour drive to the border area of Mae Hong Sorn. Pra Ajarn and I had started discussing this plan years ago while I was still pursuing my degree in Oriental Medicine. I had wanted to give something back to the area near the temple (Wat) and knew it was an area with little resources which Pra Ajarn himself had tried to help by hosting English camps and various programs. There are hill tribe communities around the Wat and even though it is only 45 minutes from Chiang Mai itself, there is a difference of night and day. Eventually however, Pra Ajarn decided to devote his time to developing the Wat as a retreat center and he has been hugely successful in that. It is the only Wat of its kind in Thailand where a master is teaching meditation to the public and guiding them through retreat after retreat in a formal temple setting.
So after some discussion we decided that an area more in need was the border area of Thailand and Burma called Mae Hong Sorn. Specifically, there is a Wat there, run by a teacher of Pra Ajarn’s called Pra Ajarn Rat. Ajarn Rat himself is extremely involved with healing and gives courses to patients on cultivating their own healing practice via meditation and his unique techniques. There was also the fact that the cave monastery was only 40 minutes from Chiang Mai and very advanced medical care, whereas Mae Hong Sorn was lacking good medical care at all. We decided this would be a better place for a clinic of alternative health practitioners, and so we were setting off on a hot May morning to investigate the possibilities.
Along the way we had to stop for the only monk meal of the day, late breakfast at around 8am. We knew about a vegetarian “restaurant,” or market stall, where we could get a veg meal for ourselves, and Pra Suriporn (Thai monks of the forest tradition are strictly vegetarian and Pra Ajarn Neewin’s monks in particular). That would be all that Pra Suriporn would eat for the day. So we had pad grapow with Thai basil, and soup with various forms of fake meat that Thais are famous for making these days. It was delicious and finally we set off again, along with bags of lychees and rambuttan that I couldn’t resist getting for the car ride. Apinya helped herself to only one complaining that they were too sticky and would cause a mess. Ah yes, I remember how clean Thai people are. They are simply disgusted at the thought of not only dirt, but mere stickiness! Even if it comes with the delightful delicacy of a fresh lychee, it is still not worth doing. I have to love them. And Apinya especially.
Apinya and I met 10 years ago, only because we were both dedicated students of Pra Ajarn’s while I was living in Chiang Mai. Then, it turned out we were both working at the University of Chiang Mai. She was a tenured professor of anthropology, and I just an English teacher. Eventually I started getting rides to the temple with her for retreats or just weekends. We worked on a translation of Pra Ajarn’s work together as well so we got to know each other a bit back then, but really I knew she was involved with this project because Pra Ajarn had asked her to be. Now however, we were getting to know and appreciate each other more. I was reading her pulse in the car and explaining why she had so much stomach trouble and that yes it had to do with eating only fruit in the morning, or with the thick white coating on her tongue. She listened excitedly and wanted to know more about how to clean up her diet. She was regularly seeing the Chinese Doctor in Chiang Mai, at a practice called Mungkala which had a wife and husband team of doctors. Dr Roongrat, the wife, had been my first exposure to Chinese Medicine and the woman who inspired me to pursue it as a life long journey. Seeing her as a patient and having her delicately touch my wrists and pulse, look into my face, feel my clammy hands and proclaim gently, “Too much water…you very special,” I knew I wanted to be what she was. She listened, she was kind, she used touch, and I always felt more whole after seeing her than I did before I walked in. I never had that experience with a doctor before. And so because of that I was determined to become a Chinese Doctor.
Apinya, however, was the loyal patient of Roongrat’s husband and partner at the Mungkala clinic. But she somehow felt a deeper understanding of her condition in the way that I explained it. She had never had diet recommendations before, perhaps because her doctor thought it was too much to ask someone to change their diet of 55 years. But Apinya was determined and excited to start right away. In return, Apinya started asking me about my birthday, made guesses about the stars in my various houses and promised to read my astrological chart.
So we arrived at Ajarn Rat’s temple in Ma Sareang and right away had a meeting with our team- Khun Pairod was a teacher at the local school and also student of Ajarn Rat. Khun S was a local official as well as a student of Ajarn Rat. On the temple grounds, they showed us a beautiful little cabin with a bedroom and bathroom that would be perfect for the volunteers to live in. There was also another cabin with about 6 beds in case we had more volunteers or a weekend seminar and needed more space. They were anxious to have us start right away as they had apparently already been telling the village that doctors would be coming. The next stop was to see where the clinic should be.
We started with a suggestion from Khun S that we use the local cremation grounds. Apinya and I both thought this was strange until about 30 minutes later when he presented us with donation envelopes for the cremation ground, which he was in charge of cleaning up. Ah-ha. We politely said the cremation grounds, though lovely, were probably not exactly the type of place we were looking for, but we did give a donation. The next idea was a rather poor temple called Wat Jongseun in the middle of the town which had a room for a clinic free and also space on the grounds for hill tribe people who came down from their villages to set up tents and stay for a few days if need be. We liked the look of this place, but then it was suggested that we go to the head abbot of the district before making any more plans. Everything in Thailand has an order and you have to go through this order if you want to be successful. If we went right to the Wat Jongsuen abbot without discussing it with the district abbot, we might find ourselves in trouble later. This hierarchy could also be extremely useful. If we went to the head district abbot first and he agreed we should be at Wat Jongsuen, then he will persuasively suggest that the abbot of this small temple let us use it for a clinic.
We met Ajarn Anusan, head abbot of the district, at Wat Sitimongkan. He greeted us warmly, though with the succinctness of a very busy man. He listened to our plan and how we wanted to bring Chinese Medicine doctors here and train people in acupuncture as well and he was very happy. He asked people in our party where they suggested and after hearing all the options he agreed that the small temple of Jongsuen was the best. So we headed back, met with the abbot who was more than happy to agree to let us use it on the condition that we pay for electricity for the temple. This would be seen as a donation we give in exchange for using the clinic and temple grounds and this temple is quite poor and barely able to make the monthly payments themselves. I said I would have to think about this, but that I hoped we could contribute.
One more option was a school about a mile away but very nice, a kindergarten actually where the teachers showed us 2 large rooms that could be used as a clinic. I asked them how they felt about having strangers on the school grounds coming to the clinic and they said no problem at all. The teachers were so lovely and I could really imagine them welcoming volunteers and making them feel at home. Mae Sareang was no Boudhanath or Chiang Mai with lots of westerners and western food if you needed it. No, I don’t there would be any other foreigners in the town except our volunteers and I know that can be lonely. We made arrangement for how lunch would be brought in daily for the volunteers and then started thinking about the option of having 2 clinics- the school on Monday and Wednesday and then the temple on Tuesday and Thursday or some variation of that. In the meantime one teacher suggested we visit Khun Sewanamit, a former teacher who spoke English well and could be our clinic interpreter.
Khun Sewanamit lives with her 85 year old father in a 100 year old Chan style house right on the river in Mae Sareang. When I walked inside I saw a man lying on the ground smelling of Thai Herbal medicine, with tattoos covering his chest and had a good feeling about the place. We spoke with Khun Sewanamit about translating for us, about her skills in English, medicine, and her interest and knowledge through her Dad in natural herbs “Sammoonprai” in Thai. She asked me to feel her father’s pulse, a strong vital blood pulse and slightly weaker but still forceful qi pulse. Her father then told us about his secrets to staying healthy which include a glass of whiskey every morning and also his credo of “Learn,” “Love,” and “Laugh” which should be done everyday. He strapped on his 85 year old looking glasses to show us how he reads the paper everyday to keep learning. Before we left she showed us plates of thai herbs he has picked and used regularly like fah ta lai jone which you see in many health shops in Thailand now, along with ginger, galanga, and tuemric.
We ate lunch next door, also a beautiful Chan style open-air house with the breeze coming in through the slats in the wall facing the river. We had traditional TaiYai food, which I had never had in Thailand before. It was a yam, a salad with unripe papaya called Bak Guey Tuet but the taste was much more peanutty and richer than any somtam, or papaya salad I had ever had before. The people in the restaurant soon knew we were doctors coming to open a free clinic here soon and they were all thrilled, already expressing gratitude and interest in Chinese Medicine. With the help of Sewanamit and her father we hope to also use Thai Herbs instead of Chinese whenever possible.
Apinya and I later met with an old student of hers who is now a dentist and whose husband studies Thai herbal medicine. She is also greatly interested in natural healing. We will work together to find the best place for a clinic, to start an exchange of natural healing methods with some well known herbalists and bone setters in Thailand, and hopefully find a way to join Chinese and Thai Medicine more efficiently in the program that we eventually establish.
Again, I feel so blessed that these circumstances are coming together and each day of my trip in Thailand I felt more and more that this work is simply meant to be. It feels like it has a life of its own and moves along despite me even. I look forward to seeing how it all turns out, but for now I am enjoying the process itself and all the learning that comes with that.
Health and Food in America
I have been treating a number of patients since returning to the States, and I am reminded that people often need education on food. It is so confusing these days what to eat and what not to eat. I had a consultation with a friend and patient this evening about the differences between organic, certified organic, natural, all natural, etc etc. Confounding! Basically, I think some good ideals to stick to if your goal is general healthy eating are inspired by Michael Pollan's In Defense of Food.
1. Eat whole foods. Eat real food, that was grown or raised somewhere close to the earth for the purposes of eating. This means stay away from things put in a box or a bag and you will be doing pretty well.
2. Don't eat food with more than 5 ingredients in it. Bread should have about 4- flour, salt, water, yeast. If there are more than 5 you are getting away from the whole food rule and into the rule which states that mixtures of food substances make up a science experiment.
3. Eat less food. We tend to overeat no matter what. A yogi once told me to eat at one sitting only what could fit into the palm of your hand. And he had energy to do 5 -8 hours of yoga a day. He was a Mysore champion!
4. If you cannot pronounce the ingredients, put it back on the shelf.
5. Eat lots and lots of veggies. There are no side-effects from vegetables, and they give us so many varied nutrients. There is really nothing bad you can say about a brussel sprout or fresh asparagus is there?
So those are good rules to try to stick to. Then if you have more specific goals in mind like eating for pre-conception, you will try to go all organic, or eating for weight loss, then you will try to do no sugar and no flour. Eating to improve digestion might look something like that with lots of greens and little sugar and flour as well. If you are concerned about the environment you will try to eat organic and local. If you do eat meat, please eat grass fed, hormone free animals that are allowed a normal life of grazing and walking before they are killed. This way you don't introduce into your system all kind of chemicals that can harm your body. Dairy too should be organic and grass fed. Take a trip to visit your local dairy farm, see how those cows are looking. Because if they are happy, you will be happy drinking their milk! That's why I love Farmer's Markets- you get to ask all kind of questions of the farmers and find out how your food is really grown, what the chickens are fed. Extra omega 3? Great, that's more for you!
And get into food. Get into it like it's your latest hobbie. Be a "foodie" I guess they call it which to me just means you are not willing to stand for bad tasting food. Once you taste organic, in-season brussel sprouts you will realize why you hated them as a kid- because you were being fed old, chemically laden, taste removed sprouts instead of the bitter, sweet, subtle tasting real thing. And cook them in butter! That's right, a whole tablespoon of it. Don't forget to do your morning walk tomorrow and you'll be fine.
But also, and this was said by Paul Pitchford of Healing with Whole Foods, remember to enjoy life! Have your guidelines you try to follow as diligently as possible because you care about your body, your emotions, your life and how you treat others, but also know when to break it, when to enjoy a piece of chocolate cake with friends, or a glass of red wine with your lover. I say this as I eat the last bite of a pint of Coconut Bliss...See? Enjoy!
A Reading List to start with:
Micheal Pollan, In Defense of Food and Omnivore's Dilemma
Barbara Kingsolver, Animal, Vegetable, Miracle
John Robbins, A Diet for New America
I was lucky enough to stop in Northern California and recruit one of my best friends and fellow SIOM graduate, Jessica Piazza for the position of Mindful Medicine Worldwide Volunteer Coordinator! This is such a huge help to MMW and I feel, yet again, so blessed to have these special people in my life who are willing to donate their time and energy to this cause. Thanks Jess!I have been back in the US for about 3 months now. Has it been that long? Besides the fact that one seems to simply bleed money here, I don't feel that different from my time in Nepal. Is it because I find myself absurdly busy wherever I am these days? Could be. But, as I told someone else the other day, I just feel that this is the time in my life for extreme work. I have been so lucky to have enjoyed times of real introspection. Three years in Thailand-let me tell you the word work was not too much in the forefront of my activities, or was it? How do we define work really? Is it only work if we are being paid or, worse, if we are miserable? My brother, who is thinking of spending a few years in silent retreat and has spent almost 10 years studying Tibetan Buddhism, soon culminating in his PhD from Harvard, was told by my Dad a few years ago that he should get a "real" job. His suggestion was that he drive a beer truck across the country, be a man among men. The irony grows when you find out that my brother has never really had a sip of alcohol in his life and is a pretty devout Buddhist. Not that Buddhist don't drink. Especially those Tibetan Buddhist who tend to be the Jesuits of the Buddhist clan. Anyway, work is work, but I guess at this point in my life I am working for the world outside myself in a very physical, time consuming way. But, just like volunteer work, I am gaining more than I give.
I am constantly surprised and elated at the outpouring of generosity from friends, acquaintances, and passersby who find out about Mindful Medicine Worldwide and who want to help. Let's see...Our amazing board of directors which is working so hard at getting our 1023 application in soon so we can give tax deductions for donations to MMW. We have been meeting monthly which is pretty hard for a group with families, partners, kids, businesses, jobs, etc. So I have to thank them so much for their support and guidance in the whole process. I am always astounded at the quality of volunteers that write in asking to volunteer- how lucky are we and also our patients in Nepal?
And most recently we have assembled a great crew of volunteers on our Fundraising Committee. These are busy, committed people who believe in MMW and want to see it flourish. So thank you Emily, Mark, Leigh, MK, Kate, Mer, Lindsay, and Barry.
In Chicago right now we are planning our first annual Wellness Day fundraiser which we hope will be a HUGE success. If you are able to come, please do and check the website for event details. It will be January 17th and we will be offering yoga, acupuncture, massage, medicinal teas, and silent auction wellness items too! If you can't make it, but would like to make a donation, please do so on our donate page of the website. Finally, we sent our second volunteer Rosanna, to Nepal on Saturday. She went equipped with great enthusiasm and supplies. We know her determination and smarts will be a valuable asset to the clinic there! You can read about her experiences here and at her own blog, soon to follow.
Since we have been fortunate enough to have had five amazing volunteers contribute their talents and skills to our clinics in Nepal in the last 10 months of operation, I wanted to share some of their patient stories and pictures with you all. Please visit their blogs as well to see more!
Vajra Varahi Clinic Chapagaon, Nepal Spring 2010
Case 1: The perfect collaterals
61 y/o woman presents with bilateral knee pain. Right knee more swollen, more painful, both cool to the touch. The skin around both knee joints and legs was very pale with many purple and dark-bright red minute collaterals (spider veins) on the medial and posterior aspects of both knee joints (SP, LR, KI, UB). Pain was constant and achey, worse when walking down stairs and in the winter. Patient was overweight, asthmatic and with low energy. She had been receiving treatment on/off for two months prior to seeing me. She experienced temporary relief from her knee pains post treatment and some improvements with her asthma and energy, but overall she was still in bad shape.
T: pale-dusky with teethmarks, and a thin white coat P: L submerged and wiry, R slippery. Slow.
Due to the nature of the minute collaterals (the bright red ones being the best) and the surrounding skin I felt she was a good candidate for blood letting. None of the other practitioners had performed blood-letting therapy. Dx: Blood, damp and cold stasis with underlying yang xu.
Tx 1: I started with the L knee lancing 3x the bright red minute collaterals, at the points where many intersect in the vicinity of UB-38 and 39. Blood was slow to come, but I managed to squeeze out 8-10 drop. Since the R knee was worse, I bled a similar area on the right UB channel then bled collaterals on her medial knee above the LR 8- Ki 10 area. In this area the blood flowed a bit more. After the bleeding I needle UB40 and UB-60 adding large moxa cones to the needles.
Tx 2: She came in 4 days later, when she didn’t have an appointment, begging me to bleed her again! She waited 4 hrs for her blood letting! The swelling and pain was still down in the knees and it was easier to walk. I was cautious about performing blood letting again so soon, because of her yang deficiency, but decided it worked so well I should do it again. I performed a similar treatment; bleeding L and R UB channel areas and the R medial area above the joint. I followed the bleeding with a SP-9 LU 5 pairing to promote circulation of fluids and qi.
Tx 3: She came in a week later and her L knee swelling and pain was gone, energy was up and breathing was easier. She asked again for bleeding on the R as it was the only tx, she felt had worked well for her knee pain. Again, I was cautious, but it became very clear to me that moving the blood stasis and cold was working and more movement needed to be done before I could do anything else. For this treatment I bled only the R side in the same areas as before and continued with a bilateral LU-5 SP-9 combo.
Tx 4: She came in a week later and was now only having discomfort in her R knee walking downstairs, and going from sitting to standing, L knee fine. Both knees were feeling warmer, less pale and overall were less painful. Energy was ok and asthma ok. I decided I had reached a plateau with the blood letting and continued treatment using needles and moxa only. I continued to see this patient on a weekly basis to treat her R knee and constitution until my time ended at the clinic.
During my time in Nepal working with this patient and others one of the VVC interpreters, Sonya, came to know and understand my affinity for blood letting. Strangely, it seemed she was always working with me on big blood letting days. She would help me to examine and identify the perfect collaterals, we would both put on latex gloves, she would grab a wade of cotton balls and be right by side to soak up blood as I poked and squeezed. It was enjoyable for both of us, because in the states I have not had as many opportunities to bleed, and with bleeding patients experience almost immediate effects. Many patients began requesting blood letting, and they were good candidates. I saw a lot of stasis of blood and cold in the channels from being constantly exposed to the cold during the winter months and working hard, long days of repetitive work in the fields.